Aortic Stenosis Treatment in India

Aortic stenosis occurs due to the narrowing of the heart’s aortic valve. When the valve does not open properly, there is a blockage or reduction in the blood flow through the heart into the main artery supplying blood to the rest of the body. Aortic stenosis can also be called aortic valve stenosis.

Aortic Stenosis Causes

• Our heart has four valves to keep the blood flow constant and correct – the aortic, mitral, pulmonary, and tricuspid valves. Each valve has flaps that help them open and close themselves once during every heartbeat. If these valves are not open or closed properly, the blood flow is reduced or blocked.
• In aortic stenosis, the aortic valve, situated between the lower left heart chamber and the aorta, does not open correctly or completely. The part through which blood flows out of the heart to the aorta is shrunk or narrowed.
• When the opening of the valve narrows, our heart needs to work harder to pump enough blood into the other parts of the body. This extra pressure on the heart can lead to the left ventricle enlarging and thickening. Gradually, heart muscles can weaken, and this can cause heart failure and various other serious heart problems.

Some other causes include:

• Congenital heart defect: Instead of three cups, some children are born with an aortic valve with only two cups. An aortic valve rarely has one or four cups. These valve defects may not cause any problems until adulthood. But, if the valve begins to leak or starts narrowing, congenital heart defects need to be replaced or repaired.
• Calcium storage on the valve: Usually, storage of calcium on the valve may not lead to any problems. Aortic valve stenosis is related to increasing age, and problems or symptoms are not noticed until the age of 70 or 80. But for some people, usually those who have congenital aortic valve defects, calcium storage may result in damage of aortic valve cups at an early age.
• Rheumatic fever: This can occur through throat infection, which can further scar the tissues over the aortic valve. Scarred tissues can shrink or narrow the opening of the aortic valve or create a rough surface on which calcium storage can take place.
  More than one heart valve can be damaged in more than one way due to rheumatic fever.

Aortic Stenosis Symptoms

Aortic valve stenosis varies from mild to severe. Signs and symptoms of aortic stenosis generally occur when the shrinking or narrowing of the valve is severe. Some people may not have symptoms for many years.

Signs and symptoms of aortic stenosis may include:

• Fluttering or rapid heartbeat (palpitation)
• An abnormal sound of the heart (heart murmur) which can be heard through a stethoscope
• Pain over the chest (angina) or tightness while doing an activity
• Feeling faint or dizzy or fainting while doing an activity
• Shortness of breath while being active
• Fatigue while performing increased activity
• Not eating properly (especially in children with aortic stenosis)
• Not gaining enough weight (especially in children with aortic stenosis)

Aortic stenosis may also lead to heart failure. Heart failure signs and symptoms include shortness of breath, fatigue, and swollen feet and ankles.

Aortic Stenosis Diagnosis

Aortic stenosis can often be found during an examination when your doctor listens to the heart rate. But murmuring sounds generally cannot reflect the severity of the aortic stenosis.

Your doctor will prescribe some tests to confirm and determine the issue or damage to your heart valve. These tests may include:

• Electrocardiogram (ECG)
• Chest X-ray
• Echocardiogram (heart ultrasound)
• Cardiac Computed Tomography (CAT scan)
• Cardiac Catheterization (heart catheterisation and or coronary angiogram).

Stages of Aortic Stenosis

The stages in patients with severe aortic stenosis are determined according to the presence or absence of cardiac damage detected by echocardiography before AVR.

• Stage 0: If no extra valvular cardiac is damaged.
• Stage 1: If the left ventricle is damaged.
• Stage 2: If the left atrial or mitral valve is damaged.
• Stage 3: If the pulmonary vasculature or tricuspid valve is damaged.
• Stage 4: If the right ventricular is damaged.

Aortic Stenosis Treatment

The treatment plan usually depends upon how severe the patient’s condition is. Mild cases require regular checkups as well as echocardiograms by the doctors.

Medications for Aortic Stenosis

Medications are administered to control the symptoms and avoid complications. Along with medications for aortic stenosis, doctors also prescribe:

• Medicine to control heart rate problems
• ACE inhibitors to help in the proper opening of blood vessels
• Beta-blockers to lower the heart rate.
• Diuretics (“water pills”) to reduce the amount of liquid in the body and ease the stress on the heart

Surgery for Aortic Stenosis

In severe cases, surgeries are done to repair the faulty valve or replace it. It includes:

Balloon Valvuloplasty

This procedure is suitable for children and for patients who are too weak for open heart surgery. It opens the faulty heart valve. A flexible, thin catheter is inserted with an attached deflated balloon via the through into the aortic valve. Once the correct location is reached, the balloon inflates and stretches the narrowed valve. The balloon then deflates and comes out from the same pathway. The effect of this procedure is temporary.

Replacement Surgeries

• Artificial or biological valve replacement: It involves aortic valve with replacement (artificial valves) or The artificial valve are of two types I.e mechanical to tissue valve. Mechanical last longer; however, patients must switch to blood thinners for the rest of their lives. Meanwhile, tissues from other animals or humans last for 10–15 years before needing to be replaced again.
• Transcatheter Aortic Valve Replacement (TAVR): Transcatheter Aortic Valve Replacement (TAVR) is similar to balloon valvuloplasty and involves using a catheter threaded to the heart’s artery. The catheter passes through the groin (transfemoral), neck (carotid), and chest (transapical). The tube carries an attached deflated balloon and the replacement valve. After positioning the replacement valve, the balloon is inflated. This positions the replacement valve at the correct place inside the damaged valve. The balloon is then deflated and removed along with a catheter.

Risk Factors of Aortic Stenosis

Risk factors of aortic valve stenosis include:

• Old age
• Some heart conditions present at birth (congenital heart disease), like a bicuspid aortic valve.
• Prior history of infections that can affect the heart valves.
• Having cardiovascular risk factors, such as high blood pressure, diabetes, and high cholesterol.
• Chronic kidney disease
• Prior history of radiation therapy over the chest.

Complications of Aortic Stenosis

Aortic valve stenosis can cause some severe complications, which include:

• Heart failure
• Stroke
• Heart rate problems (arrhythmia)
• Endocarditis infections that affect the heart

Aortic Stenosis Prevention

There are some possible ways to prevent aortic stenosis:

• Take necessary steps to prevent rheumatic fever.
• Maintain your blood pressure.
• Take care of your teeth and gums.
• Maintain your cholesterol.
• Quit smoking and alcohol.
• Maintain your blood sugar.

Epidemiology of Aortic Stenosis

• Population over the age of 65
• Population with cardiovascular diseases
• Certain heart conditions by birth, like bicuspid aortic valve
• Prior history of infection.

Expected Prognosis of Aortic Stenosis

Without any surgical treatment, the survival rate of symtomatic aortic stenosis is 2–3 years.